Long-Term Sustainability of Peri-Operative Infection Control Practices: Implementation of “Clean Cut,” a Checklist-Based Quality Improvement Program in India

Abstract

Introduction:

Surgical site infections (SSIs) are a substantial healthcare burden in low- and middle- income countries. “Clean Cut” is a checklist-based infection prevention and control (IPC) program intended to improve compliance to peri-operative IPC standards. We aim to study the short-term and long-term impact of its implementation in a tertiary care cancer referral center.

Methods:

This was a single institute, prospective interventional study. Patients undergoing elective head-neck surgical procedures were included. The “Clean Cut” program consisting of surveillance, audits, and IPC training was implemented for 6 months, after which there was no active oversight. Post-intervention (T2) and 1-year follow-up (T3) data regarding compliance to core IPC practices and SSI rates were compared with baseline (T1).

Results:

One hundred eighty six patients were included with 50 (26.9%), 86 (46.2%), and 50 (26.9%) patients at T1, T2, and T3, respectively. At baseline, teams complied with a mean of 3.56 of the six critical components of infection control processes which rose to 4.66 (p < 0.001) at T2, but decreased to 4.02 at T3 (p = 0.053). The SSI rate at baseline decreased significantly after Clean Cut implementation [16 (32%) vs. 12 (13.95%), p = 0.012], but returned to baseline levels after 1 year [17 (34%), p = 0.006].

Conclusion:

Implementation of the “Clean Cut” program increases compliance to infection control processes and reduces SSI rates in the short term. Without continuing oversight, these rates return to baseline values after 1 year.